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ABSTRACT: The choice to manage isolated frontal sinus anterior wall fractures without the involvement of nasofrontal outflow tract is mainly based on aesthetic concern and depends largely on surgeons' preferences. Minimally depressed anterior wall fractures can be monitored by observation only with little risk of long-term morbidity and contour deformity. The purposes of this study were to evaluate the course of a nonoperated depressed frontal sinus anterior wall fracture and to identify the cutoff value of anterior wall displacement requiring surgical correction.
A retrospective chart review of 51 nonoperated isolated frontal sinus anterior wall fractures was performed. The depth and area of each fracture were measured by computed tomographic scans. Medical records were carefully reviewed to identify the delayed complications or contour changes.
The mean fracture depth and size were 3.9 mm and 352 mm(2), respectively. Patients who had a fracture depth of 4 mm or less did not develop late depressive contour changes of the skin. However, 7 patients who each had a fracture depth of more than 4 mm developed mild contour changes during the months of follow-up. The delayed contour change was associated with fracture depth (P < 0.01), but the fracture area was not considered as an independent factor for delayed contour deformity (P > 0.05).
The presence of depressive contour changes on the skin is an indication for surgical correction of the frontal sinus fracture. Mildly displaced isolated frontal sinus anterior wall fractures can be observed if the fracture depression is less than 4 mm.
The Journal of craniofacial surgery 07/2012; 23(4):991-4. · 0.81 Impact Factor
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ABSTRACT: To obtain optimum aesthetic result, perioral soft tissue defects require reconstruction using similar tissue. The submental area has very similar characteristics to perioral soft tissue and consists of thin, pliable tissue with a perfect color match. Therefore, we have used submental tissues for reconstruction of perioral soft tissue defects and application of the techniques, and results are discussed in this article. Between February 2001 and April 2008, 14 perioral soft tissue reconstruction procedures using the submental tissues were performed. The defect was on the upper lip including nasal columella in 5 cases, mentum in 3 cases, and oral commissure including buccal cheek in 6 cases. The techniques that were used included composite graft in 3 cases, local advancement flap in 3 cases, pedicled flap in 5 cases, and free flap in 3 cases. Patients were followed up for 9 months to 5 years. During this period, no major complications were noted, and satisfactory aesthetic results were obtained. All transferred submental tissues survived. In all patients, donor defects were closed primarily except in cases of local advancement flap. The donor-site scar was inconspicuous and well hidden below the mandibular margin and did not restrict neck motion in all patients. In particular, hair restoration on the flap was excellent in male patients. We believe that the submental area can provide useful soft tissue for perioral soft tissue defects because it provides a good color and texture match with perioral skin and can be harvested with minimal donor-site morbidity.
The Journal of craniofacial surgery 05/2012; 23(3):934-8. · 0.81 Impact Factor
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ABSTRACT: Skin necrosis following the inadvertent arterial injection of hyaluronic acid (HA) is a serious complication. It is not clear whether or not subcutaneous injections of hyaluronidase decrease skin necrosis in HA-induced vascular complications. We had four cases of HA-induced vascular complications, two of which were treated with hyaluronidase the next day. All of the patients had skin necrosis and scarring. We performed an animal study with rabbit ears in which HA filler was injected into the auricular arteries of both ears. Five rabbits each received a subcutaneous injection of 750 IU of hyaluronidase 4 and 24 h after the filler injection. The hyaluronidase-treated ears in the 4-h intervention group had significantly smaller necrotic areas (p<0.05), while the 24-h intervention group had no differences in the area of necrosis. Hyaluronidase reduced the vascular complications of HA fillers when used early, but there was no benefit to hyaluronidase injection after 24 h.
Journal of Plastic Reconstructive & Aesthetic Surgery 07/2011; 64(12):1590-5. · 1.49 Impact Factor
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ABSTRACT: Human adipose-derived stromal cells (hASCs) produce various cytokines. Also, there is a growing opinion that a large proportion of the useful effects of cell therapy may be attributable to the secretion of cytokines. Several reports suggested beneficial effects of hASCs on skin. These include antioxidant activity, accelerated wound healing, whitening effects, and antiaging. We investigated the effect of hASCs on skin Wnt signaling, which is associated with skin regeneration and differentiation.
Pieces of human skin were cocultured with hASCs, and 2 chambered transwell culture plates were used to prevent direct contact between hASCs and skin. In the control group, pieces of skin were cultured without hASCs. Wnt1, Axin2, TCF1, LEF1, and DKK1 mRNA expressions were quantitatively assessed using real-time polymerase chain reaction. The expression levels of β-catenin were compared using Western blot and immunohistochemical analyses.
The Wnt1 and LEF1 mRNA expression of cultured skin was positively influenced by the presence of hASCs in culture medium (P<0.05). The total β-catenin protein level in hASC-cocultured skin was higher than that of the control group. Immunohistochemical staining showed that the β-catenin-stained area of dermis was larger in the hASC-cocultured group than in the control group, and most of the positively stained cells in the dermis were fibroblasts.
The results of the current study showed that hASCs promoted canonical Wnt signaling in organotypic skin culture through paracrine effects, and the increased Wnt signaling was mainly due to dermal fibroblasts.
The Journal of craniofacial surgery 03/2011; 22(2):694-8. · 0.81 Impact Factor
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ABSTRACT: Pyoderma gangrenosum is a dermatologic manifestation of systemic disease such as inflammatory bowel disease, monoclonal gammopathy, arthritis, malignancies, and Behçet's disease. Pyoderma gangrenosum can be stabilized with oral cyclosporine administration. After stabilization, it can be managed with debridement and skin graft.
Annals of plastic surgery 12/2008; 61(5):552-4. · 1.29 Impact Factor
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ABSTRACT: Pitanguy conducted a series of anatomic studies on the dermocartilaginous ligament of the nose. However, information on its structure is as yet insufficient. In addition, some of the histologic findings described by Pitanguy are controversial. The present study was undertaken to clarify the anatomy of the dermocartilaginous ligament. Sixteen cadaver noses were examined macroscopically and histologically to determine the presence, origin, insertion, composition, and relationship of the dermocartilaginous ligament with surrounding structures. There was no direct connection between the dermocartilaginous ligaments and dorsal nasal skin. This structure originated from the deep layer of the transverse nasalis muscle and terminated at the caudal edge of the septal cartilage and orbicularis oris muscle in some cases. Our histologic findings were incompatible with the use of the term ligament and demonstrated that it was in fact a fascia. Unlike Pitanguy's findings, no muscle fibers or chondrocytes were identified within the dermocartilaginous ligament.
Annals of Plastic Surgery 11/2007; 59(4):393-7. · 1.32 Impact Factor
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Plastic & Reconstructive Surgery 06/2004; 113(6):1753-5. · 3.38 Impact Factor
